Temporal changes in infective endocarditis guidelines during the last 12 years: High-level evidence needed
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Temporal changes in infective endocarditis guidelines during the last 12 years : High-level evidence needed. / Østergaard, Lauge; Valeur, Nana; Bundgaard, Henning; Butt, Jawad H; Ihlemann, Nikolaj; Køber, Lars; Fosbøl, Emil L.
I: American Heart Journal, Bind 193, 11.2017, s. 70-75.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Temporal changes in infective endocarditis guidelines during the last 12 years
T2 - High-level evidence needed
AU - Østergaard, Lauge
AU - Valeur, Nana
AU - Bundgaard, Henning
AU - Butt, Jawad H
AU - Ihlemann, Nikolaj
AU - Køber, Lars
AU - Fosbøl, Emil L
N1 - Copyright © 2017 Elsevier Inc. All rights reserved.
PY - 2017/11
Y1 - 2017/11
N2 - BACKGROUND: Infective endocarditis (IE) is a complex disease necessitating extensive clinical guidelines. The guidelines from the American Heart Association (AHA) and the European Society of Cardiology (ESC) have been markedly extended during the last 12 years. We examined the evidence base for these changes.METHODS: IE guidelines published by AHA and ESC were reviewed. We categorized and combined guidelines into 3 time periods: (1) 2004 (AHA) and 2005 (ESC), (2) 2007 (AHA) and 2009 (ESC), and (3) 2015 (AHA) and 2015 (ESC). Number of recommendations, classes of recommendations (I, II, or III), and levels of evidence (LOE) (A, B, or C) were assessed and the changes over time.RESULTS: From period 1 to period 3, we found a statistically significant increase in total number of IE recommendations from 37 to 253 (P<.01), a 6.8-fold increase. There were a significant decrease in LOE A (from 7 [20.0%] in period 1 to 4 [1.6%] in period 3, P<.0001, a 57% decrease), a nonsignificant decrease in LOE B recommendations (from 17 [48.6%] in period 1 to 115 [45.9%] in period 3, P=.29, a 6.8-fold increase), and a significant increase in LOE C recommendations (from 11 [31.4%] in period 1 to 134 [53.0%] in period 3, P=.02, a 12.2-fold increase).CONCLUSIONS: The number of IE guideline recommendations has increased 6- to 7-fold during the last decade without a corresponding increase in evidence. These results highlight the strong need for more clinical studies to improve the level of evidence in IE guidelines.
AB - BACKGROUND: Infective endocarditis (IE) is a complex disease necessitating extensive clinical guidelines. The guidelines from the American Heart Association (AHA) and the European Society of Cardiology (ESC) have been markedly extended during the last 12 years. We examined the evidence base for these changes.METHODS: IE guidelines published by AHA and ESC were reviewed. We categorized and combined guidelines into 3 time periods: (1) 2004 (AHA) and 2005 (ESC), (2) 2007 (AHA) and 2009 (ESC), and (3) 2015 (AHA) and 2015 (ESC). Number of recommendations, classes of recommendations (I, II, or III), and levels of evidence (LOE) (A, B, or C) were assessed and the changes over time.RESULTS: From period 1 to period 3, we found a statistically significant increase in total number of IE recommendations from 37 to 253 (P<.01), a 6.8-fold increase. There were a significant decrease in LOE A (from 7 [20.0%] in period 1 to 4 [1.6%] in period 3, P<.0001, a 57% decrease), a nonsignificant decrease in LOE B recommendations (from 17 [48.6%] in period 1 to 115 [45.9%] in period 3, P=.29, a 6.8-fold increase), and a significant increase in LOE C recommendations (from 11 [31.4%] in period 1 to 134 [53.0%] in period 3, P=.02, a 12.2-fold increase).CONCLUSIONS: The number of IE guideline recommendations has increased 6- to 7-fold during the last decade without a corresponding increase in evidence. These results highlight the strong need for more clinical studies to improve the level of evidence in IE guidelines.
KW - Cardiology/standards
KW - Endocarditis, Bacterial/therapy
KW - Europe
KW - Follow-Up Studies
KW - Forecasting
KW - Practice Guidelines as Topic/standards
KW - Retrospective Studies
KW - Societies, Medical
KW - United States
U2 - 10.1016/j.ahj.2017.07.018
DO - 10.1016/j.ahj.2017.07.018
M3 - Journal article
C2 - 29129257
VL - 193
SP - 70
EP - 75
JO - American Heart Journal
JF - American Heart Journal
SN - 0002-8703
ER -
ID: 194776770